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The goal of negotiating for a new medical laser is to try to get the largest possible discount off the laser manufacture’s “List price.” The list price is what a manufacturer, such as Alma Lasers or Palomar Medical, posts as the selling price. You’ll see the manufacturer’s suggested list price in many of the trade magazines such as the Aesthetic Buyers Guide or at Aesthetic Trade Shows. This is a price that is not commonly paid by most doctors, however there are many physicians who don’t like to negotiate and accept the list price as the final price. Unfortunately, they end up losing thousands of dollars in the process and even more money down the road when they try to resell it. I’ll get to how this happens a little later.

Obviously, before you even start negotiating, you need to decide which medical laser(s) you want to buy. So take the time to investigate what you’re looking for, request the manufacturers to demo their equipment in your clinic. Attend the various laser conferences and do your own research. Ask your more experienced colleagues what laser systems they have used and which ones they recommend. If you’re not part of some of the laser societies, I would strongly recommend that you join some of these organizations. A great one that I like is the American Society for Laser Medicine and Surgery (ASLMS.org). The networking aspect is tremendous and you will get invaluable user feedback on all of the major laser systems out there. Walk the floor of the trade booths and don’t be afraid to ask questions.

Try to become as knowledgeable as possible regarding laser biophysics so that you don’t get “bamboozled” by the slick “laser-techno-babble” of the sales reps. During this initial demo phase inside your clinic, never promise anything to a salesperson, never give a deposit, and never sign any type of contract. Don’t feel pressured either — if you do, inform the salesperson that you never buy any equipment on the first visit to your office.

You need to be sure that your sales reps know that you are looking at many different laser manufacturers. If they get the slightest idea that you really only want their equipment (even if you do), you have lost considerable leverage when it comes time to negotiate. You should also get comparative price quotes of each model you are testing. You can use this pricing to your advantage by having each sales rep bidding against each other on price.

You have to think outside of the box to get a good discount. The worst thing you can do is negotiate a price without having any information on the TRUE sales price. So, how do you get the true sales price? Ask for references from the sales rep in your area of other doctors he has sold to. Once you have this information, it is important that you call these doctors and ask them about their level of satisfaction with the equipment as well as how much they paid for their system. This may seem a little crass to ask for this type of information from a total stranger, however it’s your money and you could be saving thousands of dollars by doing so.

You may also know other associates who own this equipment. If you’re able to get accurate sales price information, you can use this as leverage when you are presented with an offer. The sad reality is this, whatever you pay for a new system, all new medical lasers typically depreciate by at least 40 to 50% as soon as they are sold. Even if you buy a new medical laser and never use it, it still loses at least 40% of its original value.

Why does this happen? It doesn’t really seem possible or fair does it? There are critical reasons for this and it is not by accident. One of the main reasons is that most laser manufacturers do not allow the original one year warranty to be transferred to another buyer. If you want to sell a laser you just purchased, the original warranty is voided because it is typically non-transferrable. Most doctors who are buying their first laser do not know this, and they naively sign the purchase agreement with these clauses contained in the agreement. In addition, the new buyer will need to pay a “recertification fee” to the manufacturer in order to get the laser serviced by the manufacturer.

As if that’s not painful enough, the “recertification fee” doesn’t include the warranty. The new buyer has to also purchase an entirely NEW warranty if they want the laser serviced by the manufacturer because the last warranty was just voided due to the transfer of ownership! What a racket huh? Whether these practices by the manufacturers are truly legal is highly questionable, however the sad reality is this is the standard practice inside the medical laser industry. All of this gets very expensive very quickly! In some cases, the recertification fee is in upwards of $25,000 plus a new warranty of around $10,000 = $35,000 TOTAL – just because the laser changed ownership. These extra fees charged by the manufacturer cause the value of the equipment to plummet!

Unfortunately, most doctors don’t realize this until after they’ve already bought their laser and it comes time to sell their equipment. How do you avoid this? First of all, I would highly recommend that you have your attorney review any purchase agreement you are being asked to sign before you sign it. He or she will be able to detect any clauses that are oppressive or unfair and will give you recommendations on what clauses should be revised or deleted.

This is probably the most important paragraph I am placing in this article. Please read and re-read this paragraph because it is so critically important and can save you thousands of dollars. You need to enter the purchase negotiations for a new medical laser with the goal of accomplishing these four objectives: (1) Revise the purchase agreement to allow the warranty to be transferred to a new buyer without penalties or fees of any kind, (2) Request that the warranty be extended beyond the standard one year to two or three years, (3) Eliminate any language in the agreement regarding a “recertification fee” should the laser be sold beyond the warranty period, and (4) require that the warranty include a Laser Depot service to be sure you have no downtime in your clinic. A laser depot service is when the manufacturer ships you a replacement laser should your laser break down during the warranty period. It is a critical service to have when you have just purchased a new laser. Be sure this is always included. If you can, request that the Depot service is extended through the entire life of the warranty, whether it be one year or up to three years. If you are able to accomplish these four objectives, you will be way ahead of the game.

Changing the purchase contract so that the warranty can be transferred without penalty will dramatically help you sell your laser down the road, should you choose to do so. It will also help increase the laser’s resale value and how much money ends up in your pocket. Requesting that the warranty be extended beyond a standard one year is another key strategy to help you maintain your laser and ensures that you don’t incur expensive repairs after the first year of use.

Most medical laser malfunctions and breakdowns occur after the first year of ownership, so extending the warranty to two or three years will ensure you don’t incur expensive repairs during this period. Recertification fees are the manufacturers way of leveling the playing field when competing against their own used medical lasers in the used marketplace. By having a “recertification fee” of $10,000 to $25,000, it closes the gap between the cost of a new laser versus a new one. Quite frankly they are ridiculous fees and I don’t believe they are legal, but no one has challenged the manufacturers in this area to my knowledge. What if an automobile manufacturer were to charge such bogus fees? The public would revolt! I’m not sure why it’s tolerated in the medical community.

Keep in mind that you have the greatest leverage in the negotiation process before you buy. You can never get what you don’t ask for, so ask for it! You will be surprised with the sales rep says yes to. If you are a qualified buyer, there aren’t many of you around, especially for new medical lasers! You need to exploit this fact to your greatest advantage. The strongest arrow in your quiver is your ability to “walk away” from any deal. The sales reps don’t want this to happen and they will do anything in their power to avoid this! If you do walk away, you can typically buy the exact same system on the used market for much, much less – up to 60 to 70% off! In most cases, all of this equipment can be serviced by third party repair companies without going through the manufacturer, so who needs em! If you are reading this, you obviously have access to the Internet.

Take advantage of that and inform yourself by surfing the Web. One of the most important steps you can take is to see what your laser is selling for on the used market. A good place to start is www.Dotmed.com. This is a very large Internet Portal connecting buyers and sellers of all used medical equipment.

Key word: DEMO UNIT. Often times you can secure a very good price on a “new” medical laser by asking if they have any “demo” units available. A “Demo Unit” is often times a new piece of equipment, however by calling it a “demo” unit it allows the manufacturer to “save face” and dramatically drop their sales price below the acceptable range. Most of the time if the laser is actually used, it has been used very lightly and the manufacturer still carriers at least a six month to one year warranty on the unit.

Once you’ve tested a medical laser inside your clinic, there is no need for the sales rep to return except to sign a contract. Try to maintain negotiations on the phone or by email — you will be less intimidated and less likely to falter to pressure. Some sales reps/manufacturers refuse to give you a price on the phone. Inform them that you are serious about buying and will do so quickly if offered a good price.

Make sure the final price is the final price: Compare apples with apples. Have all taxes and fees included in the final quote. Ask them, “If I were to buy this medical laser outright, and had to get a certified check, what would the amount on the check say?”

Remember that in the end, you end up with a new medical laser at a lower cost. Saving money is never a wasted effort. In addition, when it comes time to sell your medical laser, your equipment will have a higher resell value if your contract allows a transfer of the warranty and no “recertification fees!”

Once you have found the used medical laser you want to buy, you have three ways to pay for it:

Cash. Need we say more? Money talks, you know-what walks. If you can close quickly on a laser purchase you can normally negotiate a larger discount. Cash is the fastest way to close on anything and can save you significant dollars if you have it available to buy a laser. If you have the liquidity, you can bring down the price by promising to pay same day or next day. The ability to buy quickly from the seller always gets their attention and is an excellent way to save money.

Credit Card / PayPal. Not all laser brokers accept credit cards, but if they do, this is the safest way to go because you can dispute a charge if you’re having trouble with the laser or it isn’t what you were promised. Always ask the laser broker if you can pay by credit card. If you can’t pay the entire amount, perhaps you can pay some percentage of the payment with a credit card, sometimes up to 25 – 50%. In my opinion any reputable used medical laser broker should accept credit cards for all medical laser purchases. It is one of the key ways of showing they are reputable and that they stand behind the lasers they sell.

Third Party Leasing. You will typically pay a higher rate of interest if you choose to finance a used laser, in upwards of 12 to 18%. You need to personally guarantee most laser leases, which isn’t fun, and you normally can’t pay off the lease early without a prepayment penalty. You need to carefully review any type of lease agreement, especially for pay-off terms. Ideally you would like to have a lease that is similar to a loan in which you can pay it offer early without any interest penalties.

It can be difficult to secure a lease, especially with the tightening credit markets. Capital equipment makers, who had seen aggressive growth and comfortable margins before the economic slowdown, were hit hard when tight credit left few physicians available to buy big-ticket items.

There are several manufacturers from China who are now promoting their aesthetic devices on the internet and Ebay. While it is tempting to try these devices out and buy them due to their inexpensive price tag, the vast majority of this equipment is not FDA approved. Section 510(k) of the Federal Food, Drug, and Cosmetic Act requires that all medical device manufacturers must register to notify FDA, at least 90 days in advance, of their intent to market a medical device. Most foreign manufacturers have not done this. Is is therefore illegal to use these devices in the United States.

It is extremely risky to be using any equipment that is not FDA approved. It is very important to use only FDA approved devices and substances. If anything were to go wrong during the treatment, the fact that a patient was given an FDA approved treatment limits your clinic’s liability dramatically. In addition, you could be prosecuted by the FDA which is something don’t want to have happen.

As long as you follow the guidelines for use with those FDA approved aesthetic devices, you are on very safe ground. A large portion of the liability is shared by the manufacturer, and most plaintiff’s go after the entities with the deepest pockets, which are typically the manufacturers. If you are using a medical device that does not have FDA approval, you are on very shaky ground and if trouble arises, you could be the one left “holding the bag.”

It may be tempting to buy older medical laser equipment because of the great price, however you must be extremely cautious about this. The newer equipment on the market has become more user-friendly and safer to use. Using older technology can be much more “expertise” driven and in the wrong hands, can have disastrous results. Some of the problems with older technology is inadequate cooling on the skin, a lack of ongoing calibration and maintenance, and a poor user-friendly interface that helps ensure the operator provides a safe treatment. While newer equipment can never replace someone who has been properly trained in the safe user of lasers, it goes a long way to help prevent adverse reactions from occurring in the first place.

Ideally, you want to buy a laser that has seen little use that is no greater than 3 or 4 years old. If you go too far beyond this point, you can run into a lack of third party support for the laser and a lack of people who can repair it or find replacement parts. It can also be too outdated and more dangerous to use. That said, some technology has not changed dramatically over the past 8 or 9 years and it may still be worth a look, laser hair removal being a prime example If you find a laser with a low pulse count that is an older model unit (Candela Gentlelase for example), find out if the same unit is still manufactured today. If it is, then obsolescence may not be a problem and you can potentially get a really great deal on a very effective and reliable laser.

Most laser reps/brokers know very little about the equipment they are selling, aside from the one-day crash course of single-sided “facts” about their equipment that they could simply get from a datasheet. What is really bothersome is that so many doctors will believe what the reps/brokers say but not do the diligence and research it. Going off of marketing brochures really does not iterate the actual equipment or the workings of the equipment.

Get a technical explanation, if they can do it, of how the laser works. If they can’t, then you should really question their ability to know what the laser can do and why. Cost alone should not and should never be a deciding factor in buying a laser. Quality, longevity, repairs / replacements, efficacy and the light delivery methods are far more important than the cost. All too often I see doctors take the cheaper route and end up getting less of a laser that ultimately costs more in the long run, also costing them patients referrals, trust and more replacement parts to keep the laser operating it (thus keeping them in the pocket of the laser maker).

Anyone looking to buy a laser needs to pick up the phone, call around and get technical info on everything you want to consider. I recommend the following company that does an EXCELLENT job in providing laser technical information: Medical Insight. This company has some aesthetic laser charts that provide across the board comparisons of every laser that’s out there for every type of aesthetic modality.

Take your time, be patient, stay in control of your decisions and simply tell the broker exactly what you want. Don’t let them guide you into anything else, just make them give you the stats, the facts and their technical support case of why. If they cannot give you these answers on the spot or in a timely manner, say goodbye and move on to a broker and a company who will support you in this expensive and long-term decision.

There are some excellent resources for finding out which lasers are the favorites among physicians. One such resource can be found online at: www.MedicalSpaMD.com. This is a blog of aesthetic physicians who discuss very openly their experiences with all of the various manufacturers and equipment that is on the market today. Once you begin reading this information, it will become very clear which manufacturers and which equipment you should stay away from and which equipment is a favorite among the physicians in the group.

I also highly recommend that you sign up for the free webinars that are offered by almost all of the laser manufacturers. These are free, you don’t have to travel, and it allows you to get a solid idea of the benefits of the laser technology available. Attending trade shows can also be another great way to learn of the technologies that are in favor with the industry. Two shows that I recommend you attend are the American Society for Laser Medicine and Surgery (http://www.aslms.org) and The Aesthetic Show sponsored by Medical Insight (http://www.miinews.com).

Test-driving a used car helps you decide if it is the right car for you and also if this particular car is in good condition. It may not hurt to rent a laser from the manufacturer before you decide to buy so that you can give it a good “test drive.” Find out if this option is available to you. They may be able to provide you with a demo unit they can rent out to you. This will allow you to find out if the laser is a good fit for your practice.

At the beginning of the laser-buying process, many people already know the laser they want. But it’s a good idea to stop right now and test your decision with this question: Will this laser fit into my practice and my monthly budget? Buying a laser at the right price is an important first step. Developing a realistic pro forma of the revenue you anticipate generating from this laser is critical. The key word here being realistic. It is important to be sure your revenue numbers are very conservative so you won’t have problems getting a solid ROI on your new device. If your revenue numbers can easily support the price you are paying for this unit, then it may be the right laser and the right price.

Patient Population. What kind of population are you serving? gender, age range, ethnic types (Fitzpatrick Skin Types I thru VI), your surrounding competition? There is no true all-purpose laser platform. Make your determination FIRST based on your practice profile, then decide on specific platforms. It is imperative that you objectively identify your market first before making decision on laser machines. This will minimize risks of side effects or poor clinical outcomes or buying the wrong laser platform for your targeted client base.

Wavelength. If you have a patient population of darker skin types and you wish to do laser hair removal, you will need to be sure to have a laser that can treat darker skin, such as a 1064 Nd Yag. On the same token, if you have a patient population of lighter skin types you want a hair removal laser that best treats this patient base, such as an Alexandrite. If you have a mix of all skin types, then perhaps a diode laser with a long pulse width would be the best fit for you.

Profitability. If you want your practice to be profitable, you must focus on HIGH DOLLAR / HIGH MARGIN treatments. In general, the most worthwhile investment to focus on is skin resurfacing, skin tightening and body shaping (laser lipolysis, Radio Frequency). People are willing to spend big dollars to rejuvenate and tighten their face and sculpt their body. Selling larger packages typically means combination therapy which results in happier clients. It is important that you understand that your goal of increased revenue is aligned with the client wanting the best results possible Small packages or single treatments typically do not yield good results and the client walks away dissatisfied – never to return!

Spot size. The spot size of a laser determines how much skin area can be covered per laser pulse. Lasers with larger spot sizes can cover more area much more quickly. For example, a laser hair removal treatment of the back or full legs could take as long as 2 hours with older lasers. Today, these areas can be completely treated in less than 20 minutes. The spot size not only determines the speed and comfort of the treatment, but the efficacy as well.

Hertz. The hertz, or pulses per second, tells you how fast the laser emits each pulse. Some lasers can go as fast as 3 pulses per second, which allows you to cover more surface area faster. This is an important feature, especially for laser hair removal lasers.

Consumables. Some aesthetic devices are very expensive to operate, however it may still be worth your while IF you are able to charge higher prices with these same medical devices. Some examples of consumables include: Single use treatment tips, Cryogen Canisters, Coupling Fluid, Lightguides, Handpieces with a certain pulse life, Filters, Fibers, etc. You need to factor in the cost of these consumables as you create your pro forma revenue to determine your break even costs and profits.

Understanding the Technology: 3 Key Improvements to the Face: The 3 Ts.

To assist in determining what technology is best for which procedure, we have developed a very simple model that helps the practitioner to know what aesthetic equipment may best fit his practice and his patient population. For simplicity’s sake, I use the following rejuvenation model called the “3 Ts”.

a) Tone (Even Color). The goals of even color are to eliminate pigmentation and redness (facial veins)

b) Texture (Smooth Skin). The goals of texture are to smooth rough skin and reduce fine lines and wrinkles

The following chart diagrams the available aesthetic procedures and their role assisting in one of the three areas of Tone, Texture or Tighten. On a scale of 1 to 3, a 1 is considered the most effective treatment for the designated area of Tone, Texture, or Tighten while a 3 is considered the least effective treatment. 2 is considered middle of the road and not as effective.

In general, for fine wrinkle (crow’s feet) you can go with fractional skin resurfacing. For moderate to deeper ones, this is more difficult. You can go with Portrait Rhytec, CO2, Thermage, Velashape or Alma Accent. With Thermage or Accent, you get the added “lifting” effect which work better on the sagging wrinkles/skin as in the jowls or the droopy upper eyelids though a strong full ablative CO2 as in Luminis Active FX can do such for the eyelids.

Sometimes, wrinkles can also be corrected with fillers such as Radiesse, Perlane or Restylane as those on forehead or glabellar. Wrinkles can also result from tissue atrophy in the mid and lower face. In these instances, an AUGMENTATIVE volumizing injection (with Perlane or Radiesse) will stretch out the loose skin thus not only fading out the wrinkles and folds but also giving the lifting effects.

Be sure to ask your broker his opinion of the laser her or she recommends and why. This will help you to determine how knowledgeable the broker is regarding the laser technology they are selling you. Often the broker may have hands-on experience working with the laser in question. If so, that is a plus because it shows the broker has some hands-on laser operations experience.

Here are some things you need to know about the used laser market. First of all, some of the people in it are very shady. Second, it is not standardized like the used car industry. There is not a “blue-book” value for used laser equipment. Prices and quality vary widely across the board. You usually don’t get a chance to check out (or test drive) the equipment you are purchasing. There is no lemon law with used lasers. When you buy it, it’s yours. It may be difficult getting your money back if it doesn’t perform. Most of these used dealers are not real companies. They are some guy who probably doesn’t even have the laser, but is instead brokering it. There are no real warranties with the equipment. The following are things you should look for in a laser broker and ask:

Does the laser broker actually have the laser in his/her possession or is it a consignment sale? If it is a consignment sale, you need to do your own due diligence on what condition the laser is in because you can’t always rely on the broker giving you accurate information. Since the broker may have never actually physically seen the device, he/she may not know if there are any flaws with the device. He or she is relying solely on the doctor who owns the device to give him accurate information.

Has this broker been certified by third parties and received a seal of reliability and ethics? Below are a few of the certifications that can be helpful in your assessment:

Dotmed. An online website that certifies laser brokers is Dotmed (found on the internet http://www.Dotmed.com). Find out if your laser broker is Dotmed Certified.

Ebay. Every Ebay seller should have a seller’s rating. Find out if your broker has sold on the internet and what his satisfaction rating is. You want to see as close to 100% satisfaction as possible.

These certifications mean a lot to laser dealers and brokers because it validates their good reputation. Brokers and dealers who plan on selling medical lasers for many years to come do not want anything to happen to these ratings because they realize how important they are in selling equipment.

Has the broker had the equipment inspected by someone qualified to repair the laser prior to shipping? Even used lasers cost a lot of money, so it behooves you to make sure the laser that you’re buying has been properly inspected prior to purchasing. This should be done by a technician who knows the laser and should be done before you put any money down. Would you buy a used car from a fly by night dealer without having your mechanic look at it? Once it’s been purchased, all bets are off. Apply leverage to the broker when you have leverage, and that is prior to purchasing.

Many brokers tout that their laser equipment has been “refurbished.” This statement means absolutely nothing if the laser broker cannot provide documentation of the laser’s refurbishment. If they claim it has been refurbished, they should be able to send you a checklist of items that have been done to the laser in a matter of minutes via email or fax. If they cannot provide this to you in relatively short order, then nothing has been truly done to this unit.

If you have any doubt as to the laser’s condition, you can also ask the broker to shoot a video of the laser in operation, showing the following:

1. The laser being fired
2. The pulse count on the screen
3. The user adjusting the treatment parameters on the screen
4. The serial number of the unit.
5. Any material defects the laser may have that need to be disclosed

The bottom line is this: You want to make sure the laser is in good, operating condition. You need to make sure it is actually functioning. Shooting video these days is extremely easy. You can buy a Flip HD video camcorder for less than $200 and shoot high resolution video that can be uploaded directly to YouTube in a matter of minutes. Don’t let this process intimidate you. You are about to make a very large investment. Asking these items of your broker shouldn’t be seen as excessive.

4. The Importance of a Laser Inspection Checklist

How do you know if a laser has been inspected or “refurbished”? Ask for a laser inspection checklist that has been completed by someone qualified to perform the inspection. Below is a basic laser checklist THAT SHOULD BE PERFORMED ON ANY LASER PRIOR TO BEING SOLD TO ANOTHER PARTY:

In most cases, the inspection checklist will not have been performed prior to the broker listing the item, however you should make it a condition of the sale that the laser be properly inspected. If you do not require this, you will be buying at your own risk.

Can the broker provide you with a service report on the laser while it was under the manufacturers warranty? In addition to the laser inspection checklist, you should also request any and all laser service reports that documents any maintenance that has been done on the laser since it was purchased new. Sometimes the selling doctor may no longer have a record of this, however this should also be available from the laser manufacturer. Manufacturers have a responsibility to document all repair and maintenance work that has been done to the laser as part of any warranty they have provided for the laser when it was purchased new.

Brokers can be hesitant to provide you with a serial number of the laser because they do not own the laser. With a serial number you can call the manufacturer and find out where the laser is and sometimes who actually owns the laser. This makes brokers nervous because it means that you can potentially go around them and buy directly from the owner of the laser unit. Such behavior is completely unethical, however it does sometimes happen which is why laser brokers are very careful about providing such information to you.

Can the broker provide you with at least 5 references within the past 3 months of doctors he has sold to?Not every transaction will always run smoothly every time with a broker, however does the broker adjust to problems and ensure that things get back on track to keep the buyer happy? Calling references of recent transactions will allow you to find out from buyer’s their level of satisfaction with the broker and whether they would do business with him or her again.